Even minimal adherence to both reduced ED visits, hospitalizations

Action Points

Note that this analysis of Medicare data suggested that adherence to chronic obstructive pulmonary disease and depression medications reduced emergency department utilization among individuals with both conditions.

Be aware that adherence to medications may be a marker of other healthful behaviors and not directly causative of improved outcomes.

Treating depression and chronic obstructive pulmonary disease (COPD) in patients with both conditions reduced hospital emergency department (ED) and hospitalizations, according to a retrospective analysis of Medicare data.

Of the 16,075 beneficiaries meeting study inclusion criteria, 21% achieved adherence ≥80% to COPD maintenance medications and 55% achieved adherence ≥80% to antidepressants, reported Linda Simoni-Wastila, PhD, of the University of Maryland in Baltimore, and colleagues.

Compared with no use and controlling for antidepressant adherence and potential confounders, higher (≥80%) levels of adherence to COPD maintenance medications were associated with decreased risk of hospital ED visits (hazard ratio 0.79, 95% CI 0.74-0.83) and hospitalizations (HR 0.82, 95% CI 0.78-0.87), they wrote in Respiratory Medicine.

Patients who were nonadherent and did not use the medications were up to 30% more likely than those with even minimal adherence to COPD maintenance medications and antidepressants to have an ED visit or hospitalization during the follow up, the authors noted.

Also, the low ≥80% adherence rate suggested that depression may interact with COPD to further reduce adherence, they stated.

The is among the first to link co-treatment of COPD and depression to better outcomes in patients with both conditions, the authors said.

"This study provides some of the earliest evidence that understanding the interplay between medication regiments for COPD and depression is vital to preventing potentially avoidable emergency department visits and hospitalizations," they wrote.

In an interview with MedPage Today, Simoni-Wastila said while depression is a common comorbidity in patients with COPD, it is often unrecognized and untreated. Depression and anxiety are often difficult to identify because their symptoms often overlap with those of COPD.

"Pulmonologists have not traditionally been trained to consider the anxiety and depression that often accompanies COPD, and psychiatrists treating patients for depression may ask them about their COPD, but it's not usually a focus," she said.

Simoni-Wastila noted that both psychological and biological factors, such prolonged lack of oxygen to the brain, contribute to a greatly increased risk for depression in patients with COPD.

But previous studies examining the impact of depression and anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs), on COPD outcomes have been inconclusive.

In a recent review examining the impact depression and anxiety have on COPD outcomes, researchers reported that less than a third of COPD patients with comorbid depression or anxiety receive adequate treatment for these conditions.

The current study included a random 5% sample of Medicare beneficiaries actively enrolled from 2006 to 2012 who had a co-diagnosis of COPD and depression. All study participants had at least two prescription fills for both COPD maintenance medication and antidepressants.

The researchers measured adherence to medications using the proportion of days covered per 30-day period.

Primary outcomes were all-cause ED visits and hospitalizations, and all beneficiaries were followed for a minimum of 12 months.

Adherence to antidepressant treatments was higher than that for COPD maintenance medications, with 55% of the study cohort achieving adherence of ≥80%.

Study limitations included the necessary reliance on Medicare claims data for the assessment of medication adherence and healthcare utilization, without confirmatory laboratory confirmation of COPD diagnosis and severity of airway obstruction.

"It is possible that there is residual confounding of our results by COPD complexity, despite our strict inclusion criteria and controlling for oxygen and COPD acute medication use," the authors wrote. "Challenges also include measuring adherence to inhaled medications using administrative claims data."

Additionally, the study design did not allow the researchers to examine whether COPD and depression treatment has a specific impact on COPD exacerbations.

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